More $%#@ing pay cuts!

[dr.evil]

I dropped out of AMSA after medical school once I realized that it's a worthless political bureaucracy of no help to future or current physicians. They are NOT looking out for the physicians but their organization. Just crap.

We all probably just need to quit begging the government for help. I'm sick of every year having to beg and plead some hooker banging bureaucrat to not cut Medicare. I'm on board with just telling the to cut our arms and legs off and throw us in the ocean. We're pretty intelligent people. We'll figure out how to swim. Once the reimbursements are dropped further, we as physicians will finally tell them to screw themselves, and a true "crisis" will happen.

Docs are just scared to drop Medicare. Especially those in poor areas of the country. They're a huge chunk of your income.

Government + medicine = chaos and GI distress

---

Members don't see this ad.

 

[HMSBeagle]

Is it me or surgeons are more affected by these cuts than the other medical specialties? If so why?

 

[Castro Viejo]

Is it me or surgeons are more affected by these cuts than the other medical specialties? If so why?

Well, sort of. If you look back at how these cuts are made, you'll sort of begin to see a wholesale discrimination against surgery and its various subdisciplines. There's almost a guaranteed 1% reduction per year in the reimbursement forumla for most operations. Every now and then they'll throw us a bone and give us a 1% increase for a year, only to take 2% the following year.

Other specialties have had their hard times too, but not as negatively as surgery. Malpractice for surgeons rise at a somewhat faster rate than for other physicians, yet our reimbursements constantly get slashed.

We're beginning to see the same thing happen with Radiology, as MedPAC/CMS is beginning to screw with them. Last I read they sustained a 25% reduction in fees and are expecting more cuts in the years to come. That may be why Radiology isn't quite as popular as it once was. Weren't there a whole mess of open spots after the match for Rads?

The continuing problem is MedPAC's use of the Sustainable Growth Rate (SGR) formula developed by a bunch of suits for calculating what you and I will be paid. It's an outdated formula that's screwing us all the time. Once we can move away from the SGR, we may see some positive things happen for physicians. But that'll all come at some price, I'm sure. P4P perhaps? I dunno. I'm getting ready to study for the GMAT once I finish my boards.

 

[GSresident]

What has AMSA done for us students? Wait, whats that....ohh thats right NOTHING!!

The douchebags (I use that in a medical sense) who run for office for the AMSA get to put it on their resume. That is about it. Not many of those social climbers think much about the consequences that their liberal nonsense has on medicine. They only think 'I might get plastic surgery if I am president of the AMSA.'

I never joined the AMA or the AMSA and I never will. I don't need an organization telling me that I am a greedy bastard or that I need to buy a certain kind of toaster.

Look into the American Association of Physicians and Surgeons.

 

[eclipsey]

Two words everyone...Ron Paul

Too bad he got the boot from the liberal biased media (and Fox News) when they refused to put him on debates or ask him any meaningful questions. That man is an economic genius compared to the likes of anyone else running in this election. Its unfortunate that his name was not well publicized and his ideas were left for dead. I really do believe he was the only hope in pointing us in the right direction...

 

[HMSBeagle]

The douchebags (I use that in a medical sense) who run for office for the AMSA get to put it on their resume. That is about it. Not many of those social climbers think much about the consequences that their liberal nonsense has on medicine. They only think 'I might get plastic surgery if I am president of the AMSA.'

.

I think AMSA may sometimes backfire on you. Attendings at interviews may think you are a crazy radical liberal and write you off. I mean I have no experience interviewing yet but this has probably happened to someone out there even if they dont know or may never know it.

 

[AwesomO]

Two words everyone...Ron Paul

Too bad he got the boot from the liberal biased media (and Fox News) when they refused to put him on debates or ask him any meaningful questions. That man is an economic genius compared to the likes of anyone else running in this election. Its unfortunate that his name was not well publicized and his ideas were left for dead. I really do believe he was the only hope in pointing us in the right direction...

I like Ron Paul but theres no way he would of won the nomination fair treatment or not. His ideas although mostly great would scare the crap out of the average American.

 

[Castro Viejo]

I like Ron Paul but theres no way he would of won the nomination fair treatment or not. His ideas although mostly great would scare the crap out of the average American.

Unfortunately the average American is pretty stupid.

 

[eclipsey]

Unfortunately the average American is pretty stupid.

Yes sir.

The average American has no idea, and wants no idea, what goes on during a day-to-day basis in our government. Ron Paul's ideas only support and perpetuate what our founding fathers have established for us already. Instead, because of the way this country has become set up, a few minority rule, everyone else is out of luck.

Castro, nothing taking away from voting Conservative - as I have claimed myself to be one for a long time - but are the American people really so blind as to want to put a man who was in solitary confinement camps for 5 years in the most powerful position in the world? I absolutely agree we can't vote for Hilary or Obama, as both support a socialized health care plan .

 

[Castro Viejo]

Castro, nothing taking away from voting Conservative - as I have claimed myself to be one for a long time - but are the American people really so blind as to want to put a man who was in solitary confinement camps for 5 years in the most powerful position in the world? I absolutely agree we can't vote for Hilary or Obama, as both support a socialized health care plan .

Compared to the carpet bagger senator from New York who cackles like a hyena and cries on national television because "the stress is getting to her" and the junior senator from Illinois who's got NO record, NO experience, and offers NOTHING other than a bunch of empty slogans ("Change We Can Believe In," "Hope for America," etc.), I'll take my chances with the guy who was holed up in a POW camp and probably has some rip-roaring PTSD than an Ivy League grad who apparently failed English grammar in grade school.


"Change in Which We Can Believe."

 

[eclipsey]

While I agree..I think it's still a lose/lose situation. We have 585,000+ troops across seas..bringing them home alone would save us billions. I think the biggest problem I have with McCain is his ideas to keep permanent bases in Iraq to be there for a million years, his super liberal view on boarder security (being from Arizona, can you blame him?), and selling the people out for bigger government programs. This isn't how the conservative party was meant to be run.

 

[San_Juan_Sun]

Compared to the carpet bagger senator from New York who cackles like a hyena and cries on national television because "the stress is getting to her"

I like to call her "America's Mother-In-Law".

 

[tacobell]

Capitalist system means, as a business or provider of services, you can offer your services to whom you want to on your terms.

One solution - STOP PARTICIPATING WITH HEALTH INSURANCE PLANS! You sign a contract and agree to accept some fraction of what the Medicare fee schedule is. Almost all insurance plans peg their rates on Medicare. If you don't participate with them, you can bill what is termed "full and customary" which is usually 3 to 4 times what you would have agreed to. Most (if not all) private plans have an out-of-network benefits clause. Downside: your elective practice will take a heavy hit -> PCP's won't refer to you unless their patients can be covered by their insurance. HOWEVER, if every GS in a given geographical area were to not participate, then the patient would have to get covered by out-of-network benfits. Unfortunately, I thinks this smacks of collusion and would probably get some insurance company's legal department in a tizzy. Besides, there's not enough cohesiveness among physicians for this to ever happen.

The upside - patients seen in the ED who do have insurance can be billed "full and customary" fees if you don't participate in their insurance and the insurance companies (almost always) have to pay what you bill. That $350 appy if you take United becomes a $1700 appy (figures for illustrative purposes). This makes up for the self-pays whom you probably will be lucky to get anything from. And if you see someone in your office that you really do want to help and they have insurance, you have the option of asking their insurance company to allow you to do the surgery as long as they will pay you what they would have if you did participate with that plan (and they usually say OK).

Of course, this does nothing about Medicare pay cuts, etc. but it does feel nice to screw the insurance companies back a little bit. Like I said, this would only work if all the specialists in a given area developed the same business model ... probably never happen.

 

[AwesomO]

Thought castro may get a kick out of this thread. http://forums.studentdoctor.net/showthread.php?t=509979

Full of idealistic med students to boot!

 

[Castro Viejo]

Of course, this does nothing about Medicare pay cuts, etc. but it does feel nice to screw the insurance companies back a little bit. Like I said, this would only work if all the specialists in a given area developed the same business model ... probably never happen.

I spoke with a gentleman from around these parts who told me about his "practice model" that sounded a bit like fraud, sort of how you describe, but way more devious.

I won't divulge it here in public, as I don't know exactly understand the legalities of this kind of stuff (nor do I quite understand the economics surrounding it), but suffice it to say that most practices' payor mix is going to be primarily Medicare if I'm not mistaken. The private insurance patients, when you get them and you can garner the out of network fee somehow, are just icing on the cake -- but it's no real way to build your referral base.

Besides, who really wants to be a slave to ED call for the rest of his career?

 

[Punchap]

Believe me, I know.

Most medical students and premeds are nothing more than a bunch of liberals who will balk at anything remotely conservative. It's just not cool these days.

Fast forward a few years after they've been in residency a while or are in practice, and they'll see how ******ed it is to be a liberal when they've worked their butts off for so long only for a Democratic President to want more money out of their pockets and redistribute it to "that guy who's too poor to afford to pay doctors' fees and drove to his appointments in a brand spanking new BMW."

And that's why organizations like AMSA burn me up. Instead of educating medical students about the realities of medical practice, medical economics, and what to do to position themselves and the profession more aggressively in the future to fight reimbursement cutbacks, they spew this ultra-liberal/"progressive" bull$hit that the uninsured in America are our profession's problem and, somehow, medical students can fix it by holding candlelight vigils, sit-ins, and other stupid hippy crap.

I have thoroughly enjoyed reading this thread...particularly Castro's contribution.

I just recently decided to drop AMSA for the very reasons described here. My pre-med AMSA chapter meetings were nothing more than ultra-liberal, self-congratulatory lunches during which we described the latest MM-like documentary, held unsuccessful feel-goodery campaigns and spent charitable money on T-shirts and other paraphernalia that declare "healthcare is a right, not a privilege"...all for the sake of resume-building. Sorry for all the hyphens.

BTW....I feel very behind. You all discuss how you are saving your money now while you can. What's your advice for someone who can bank on being in the red for at least 8 more years?

 

[eclipsey]

BTW....I feel very behind. You all discuss how you are saving your money now while you can. What's your advice for someone who can bank on being in the red for at least 8 more years?

As a follow up to this: In this current situation we have been discussing, if you were to go back to starting your junior year in college, would you go through and become a physician, knowing what you know now? It seems like a losing situation from a business/financial stand point, even though one's love for medicine should not be focused around the paycheck, one must still think rationally. It only seems like it will be getting worse as time goes on in this country...

 

[AwesomO]

I just recently decided to drop AMSA for the very reasons described here. My pre-med AMSA chapter meetings were nothing more than ultra-liberal, self-congratulatory lunches during which we described the latest MM-like documentary, held unsuccessful feel-goodery campaigns and spent charitable money on T-shirts and other paraphernalia that declare "healthcare is a right, not a privilege"...all for the sake of resume-building. Sorry for all the hyphens.

To be fair that seems like the activities pretty much any premed club engages in.

 

[eclipsey]

Wait a second..what is going on in Castro's sig and under his name? "Obamanator"? Lol, I hope he's being facetious.

 

[droliver]

The upside - patients seen in the ED who do have insurance can be billed "full and customary" fees if you don't participate in their insurance and the insurance companies (almost always) have to pay what you bill.

That's not exactly how it works in practice.

You can bill United or whomever whatever you want, but even out of network you'll be reimbursed only what they pay for their out of network rates. You can balance bill the patient for the difference, but that just tends to accumulate large accounts recievable for your practice which will NEVER be realized & leaves you with a practice full of patients who are angry and resentful they're getting bills or collection notices from your office.

Even the out-of-network games is rigged as payors index their rates to data on average "customary fees" for providers from a company called INGENIX, who just happens to be owned by.......United Healthcare Inc. Ingenix & UHC are being sued currently by the State of New York for manipulating the data to (as hard as it is to believe) selectively exclude most of the higher fees out of the data used to average the rates they publish which pushes the mean down a lot.

 

[Castro Viejo]

Wait a second..what is going on in Castro's sig and under his name? "Obamanator"? Lol, I hope he's being facetious.

Meaning I'm not a fan.

And, no, that doesn't make me a racist.

 

[Castro Viejo]

Even the out-of-network games is rigged as payors index their rates to data on average "customary fees" for providers from a company called INGENIX, who just happens to be owned by.......United Healthcare Inc. Ingenix & UHC are being sued currently by the State of New York for manipulating the data to (as hard as it is to believe) selectively exclude most of the higher fees out of the data used to average the rates they publish which pushes the mean down a lot.

Andrew Cuomo is quite the bad a$$ Attorney General in New York State. Sort of like what Eliot Spitzer was before he became "Client-9."

I hope this investigation finds UHC and Ingenix were in collusion to screw physicians in the state. It could very well give birth to new regulatory agencies that will oversee health insurance companies and their bullcrap, unfair practices.

God Bless the State of New York.

 

[eclipsey]

Racist?

How can you like a man with empty dream slogans while perpetuating a false hope with the millions that support him?

That's not racism, that's seeing through bullsh*t.

 

[tacobell]

droliver - i didn't know that (re:Ingenix) - would you agree that typically, though, out of network is usually about 2 to 3x more than participating fee schedule?

c.viejo - if what my billing people tell me is true, a practice with just medicaire pts wouldn't be that bad - most negotiated fee schedules are close and often less then what medicare pays (any thoughts droliver?). plus it's usually much less hassle to get pre-cert and payments from medicare than private payors. as a future vasc attending i expect you're going to be seeing a lot of medicare anyway.

finally, i've heard that most GS pratices get about 25 to 30% of their income from ED - I'd be interested to find out what others have heard

 

[nonesuchgirl]

Castro, at the moment I have nothing productive to add, but a] I love you, and b] I'm a non-scarily-liberal-pre-allo kid. There's hope.

Great thread.

 

[Castro Viejo]

c.viejo - if what my billing people tell me is true, a practice with just medicaire pts wouldn't be that bad - most negotiated fee schedules are close and often less then what medicare pays (any thoughts droliver?). plus it's usually much less hassle to get pre-cert and payments from medicare than private payors. as a future vasc attending i expect you're going to be seeing a lot of medicare anyway.

The faculty practice here in General Surgery (a community hospital in New York City) is typically 50-75% Medicare, according to the practice manager. They seem to be doing okay. And, yes, I believe that the majority of Vascular Surgery practices in major metropolitan areas are going to be Medicare based as well.

But therein lies the problem with the current system. Remember the SGR formula maintains that for the system to survive, cuts have to be made in things like surgery and imaging. And that's all we've seen so far in the last decade or so. So when so many of these practices have a foundation in CMS/MedPAC, cuts all around will hurt. Opting out of Medicare is not something that can be done easily -- at least not in New York City -- and expect to survive.

And, as far as Vascular Surgery is specifically concerned, I believe an article I read in one of the General Surgery newspapers a few months ago said something to the effect that CMS would no longer pay for routine Vascular Laboratory studies (Duplex Ultrasounds, PVRs, ABIs, etc.). That could hurt a lot of Vascular Surgeons and it sounds like a bad idea.

finally, i've heard that most GS pratices get about 25 to 30% of their income from ED - I'd be interested to find out what others have heard

I suppose it depends more on how far along in practice you are, taking into account the environment in which you practice.

The senior-most attendings in my institutions take zero ED call, yet they have more cases on the schedule than most of the younger guys who often cover one in four nights. The most junior guy I know, who was my former Chief Resident, once took 25 days of call in a month (covering two hospitals) over the hoidays.

Sounds painful? Yeah, it is...

 

[Punchap]

In the spirit of this thread, please visit:

http://stuffwhitepeoplelike.wordpress.com/ and see post #94

Warning: This blog may be offensive to those who take themselves too seriously or have no sense of humor.

 

[tacobell]

http://www.facs.org/fellows_info/bulletin/2007/degroote0407.pdf

("Economics of Managed Care Reimbursement: A rationale for nonparticipation")

It's a quick read but I'll try to get to the highlights:

This group's profit per RVU was $6.59 per RVU (hernia repair is 12.38 RVUs; colon resection is 32.36 RVUs) (with Medicare)

See Table 1 for how much some standard procedures rate in terms of profit
(breast biopsy $73.93 - Whipple $485.81)

The profit per RVU was even less for Aetna, United and Oxford

When one compares profit per RVU re: full/customary vs. in-network, the in-network profit per RVU is approximately 5 to 6% of the profit per RVU with full-customary fee schedule

Private veterinary insurance pays roughly twice what Medicare pays for analagous procedures IN HUMANS!

Average hourly salary for GS - $83.74; avergae hourly salary for managed care CEOs $1,423

 

[Castro Viejo]

http://www.facs.org/fellows_info/bulletin/2007/degroote0407.pdf

("Economics of Managed Care Reimbursement: A rationale for nonparticipation")

It's a quick read but I'll try to get to the highlights:

This group's profit per RVU was $6.59 per RVU (hernia repair is 12.38 RVUs; colon resection is 32.36 RVUs) (with Medicare)

See Table 1 for how much some standard procedures rate in terms of profit
(breast biopsy $73.93 - Whipple $485.81)

The profit per RVU was even less for Aetna, United and Oxford

When one compares profit per RVU re: full/customary vs. in-network, the in-network profit per RVU is approximately 5 to 6% of the profit per RVU with full-customary fee schedule

Private veterinary insurance pays roughly twice what Medicare pays for analagous procedures IN HUMANS!

Average hourly salary for GS - $83.74; avergae hourly salary for managed care CEOs $1,423

Read it a while ago. Made my stomach turn.

Time to get an MBA.

 

[droliver]

droliver - i didn't know that (re:Ingenix) - would you agree that typically, though, out of network is usually about 2 to 3x more than participating fee schedule?

if what my billing people tell me is true, a practice with just medicaire pts wouldn't be that bad - most negotiated fee schedules are close and often less then what medicare pays (any thoughts droliver?). plus it's usually much less hassle to get pre-cert and payments from medicare than private payors. as a future vasc attending i expect you're going to be seeing a lot of medicare anyway.

Charges submitted for out of network providers rely on the willingness of patients to actually pay for huge deductibles and co-pays they incur in these scenarios. My experience is that a huge % of these patients are unwilling to pay their obligation and fall into your accounts recievable column on the ledger. This is particularly true when patients do not understand their obligation & scope of their insurance policy. They get real P.O.'d when they think their insurance should cover everything and feel you're being "greedy" when they get told that your charge is above the "usual & customary" fee (again rigged by INGENIX). At the end of the day you send them notices and either write it off or send it to collections.

If you've carved out a niche doing true fee-for-service you have them pay in advance.

Medicare is slightly more uniform in how they treat things (which is why your billing people like it) but their fee schedule lags better paying privates signifigantly. A practice dependent on medicare is going to do worse and worse financially as they reimbursement lags inflationary growth of running your practice.

 

[balaguru]

...Time to get an MBA.

Just curious, are you being serious about the MBA? You've mentioned it a couple of times. Just wondering, because in my perhaps limited experience an MBA is neither necessary nor sufficient to be successful in business. As much as these pay cuts suck I think it will always remain possible to build capital and be enterprising if that's what you want.

 

[HMSBeagle]

As much as these pay cuts suck I think it will always remain possible to build capital and be enterprising if that's what you want.

I agree.

 

[jubb]

Can I just say amen to the stuff said about AMSA and young medical students. I think I went to about half a meeting before I realized how out of touch with reality they are. It was welcome seeing all those 1st and 2nd year liberal medical students with no real life experience end up fairly more conservative after spending a small amount of time interacting with real people in the hospital. Realizing that a lot of the people they used to be so enthused about helping aren't oppressed or victims of something, but just continuously make bad decisions and refuse to help themselves. Then they ask themselves Why should we put so much effort into doing everything for these people so they can continue to make bad decisions. Then they also realize that they are going to be those rich people who they used to be so fond of taxing and that they have to pay off their 150k-200k of students debt with what's left over after the robin hood government robs them.

I wish I could believe that it was all those realizations I just listed that made them turn conservative, but that would be giving them too much credit as they are more likely just sheep. They went to college where it was cool to be liberal and then went to the hospital where it's cool to be conservative.

On another note, I think surgeons are hit way harder by the pay cuts because of the global fee structure and the rising cost of overhead. When they consider what to pay you for an operation they are probably thinking of what you should be paid for the 2 hours you are in the OR, not the time spent seeing the patient in the ER, not the time spent waiting for the OR team to get ready, not the time spent rounding on the patient, not the time spent in follow up in the office, not the cost of employing people to run your office, not the price of offering health care plans to your employees, not the rising cost of malpractice insurance. It just hits surgeons harder. I hate it because I always wanted to run my own practice someday, but it seems like we'll all be hospital or worse government employees before too long.

Justin

All these obama supporters are having "obasms", but they'll regret it the morning after.

 

[Castro Viejo]

Just curious, are you being serious about the MBA? You've mentioned it a couple of times. Just wondering, because in my perhaps limited experience an MBA is neither necessary nor sufficient to be successful in business. As much as these pay cuts suck I think it will always remain possible to build capital and be enterprising if that's what you want.

Perhaps. An MBA may not be necessary, but experience and a resume certainly are a requirement in business. For the majority of us our entire lives have been in school only to graduate to residency training (i.e., more school), giving us an impressive resume in general, but hardly useful if you wanted to be one of those Wall Street jackals. From my conversations with people in finance, an MBA would be a sure way to mark your resume (with your experience) as someone who would be suitable for a particular subset of jobs on Wall Street. I only mention it really in jest, but who knows?

 

[Castro Viejo]

They went to college where it was cool to be liberal...

It certainly got you more putty-tang.

I hate it because I always wanted to run my own practice someday, but it seems like we'll all be hospital or worse government employees before too long.

There's always group practice to "spread the wealth."

 

[fab4fan]

Wow, man... You've really changed my opinion of the French.

Are you really French or are you a "stupid American capitalist" in French clothing?

Good for you. Welcome to the United States of America. Make sure you don't vote for a Democrat.

But you're another person who sides with me. Where are you people? The people who think we should work for next to nothing and care for people for free! The people who think "Patch Adams" was a great and inspiring movie. I vomited when I watched that. (Just kidding...) It's way too late (in New York City at least) to be out on one of your candlelight vigils with the hobos in the park. Come out, come out, wherever you are...

Dear God.

A friend of mine (not a nurse) dragged me to see Patch Adams. When the lights came up in the theater after the movie ended she said, "Oh, I thought that was great! Did you like it?" I said "I hated it. It was even worse than Dune, and I didn't think it was possible for a movie to be more awful than that."

You should read Roger Ebert's review of Patch Adams sometime just for laughs.

http://rogerebert.suntimes.com/apps/pbcs.dll/article?AID=/19981225/REVIEWS/812250305/1023

There should be a way to report people who are abusing clinics, but I suspect if you reported them they would go crying to hospital admin., and somehow your "anonymous" report would come back to bite you. Hospitals are all about "customer service," you know, even the bad customers. It's ridiculous. The other day I had someone demand (yes, demand) to be given a tour of an OR. I was .

And no, he did not get his tour.

 

[fab4fan]

Two words everyone...Ron Paul

Too bad he got the boot from the liberal biased media (and Fox News) when they refused to put him on debates or ask him any meaningful questions. That man is an economic genius compared to the likes of anyone else running in this election. Its unfortunate that his name was not well publicized and his ideas were left for dead. I really do believe he was the only hope in pointing us in the right direction...

I liked him as well and was very frustrated at his treatment during the debates. It was obvious he was not being taken seriously.

 

[Castro Viejo]

A friend of mine (not a nurse) dragged me to see "Patch Adams." When the lights came up in the theater after the movie ended she said, "Oh, I thought that was great! Did you like it?" I said "I hated it. It was even worse than Dune, and I didn't think it was possible for a movie to be more awful than that."

You've never seen "Very Bad Things," have you?

But I agree. The everydayman will watch Patch Adams and think it's a wonderful story, but people in healthcare know that it's not so simple as the patients are helpless and the physicians/hospital staff are bastards.

There should be a way to report people who are abusing clinics, but I suspect if you reported them they would go crying to hospital admin., and somehow your "anonymous" report would come back to bite you. Hospitals are all about "customer service," you know, even the bad customers. It's ridiculous. The other day I had someone demand (yes, demand) to be given a tour of an OR. I was .

And no, he did not get his tour.

I'm sure it would. I don't see how that would be protected in any way.

Hospitals are too focused on customer service nowadays and make the delivery of healthcare look and feel like one is ordering something off a menu. Hell, if that's how they wanna play it, then we could just withold care until payment in full is received.

Then again, that ain't right.

 

[fab4fan]

I've never seen Very Bad Things, so I looked it up. This key quote made me laugh:

If you think this movie is funny, that tells me things about you I don't want to know.

Which makes me wonder: If I laughed at that, does that make me a bad person? Oh well.

Something has to change. Our priorities are out of whack. I don't mind paying taxes for health care for people who truly need it and don't have the means to obtain it, but I'm not interested in giving a free ride to people who are going off to Cancun for vacations. I haven't had a decent vacation in a couple of years. I 've been paying off loans and paying for going back to school. How foolish.

 

[StealthNerd]

I dropped out of AMSA after medical school once I realized that it's a worthless political bureaucracy of no help to future or current physicians. They are NOT looking out for the physicians but their organization. Just crap.

We all probably just need to quit begging the government for help. I'm sick of every year having to beg and plead some hooker banging bureaucrat to not cut Medicare. I'm on board with just telling the to cut our arms and legs off and throw us in the ocean. We're pretty intelligent people. We'll figure out how to swim. Once the reimbursements are dropped further, we as physicians will finally tell them to screw themselves, and a true "crisis" will happen.

Docs are just scared to drop Medicare. Especially those in poor areas of the country. They're a huge chunk of your income.

Government + medicine = chaos and GI distress

Exactly. ... If you haven't yet read Atlas Shrugged by Ayn Rand, you should. I'm about midway through it and it's quite the eye-opener. She can be a bit long-winded but overall the message is pretty clear: it's all about rational self-interest. I'm reading this book and think "No way this could happen in the United States"... and then sometimes I realize that it very well could. You f*ck with the intelligent, productive people too much and they'll leave.

The only question is: where do we go? ... ... Anyone know anything about life in New Zealand? I hear it's pretty there.